Wiki Incident to billing and Group NPI

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holliet

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I have one MD and four NPs. My office has a group (type 2) NPI and each provider has an individual NPI.
For Medicare patients, if the claims are billed with supervising provider under the group NPI and rendering provider is individual nurse practitioners NPI is this considered incident to billing? In this scenario can the NP see a new Medicare patient/problem, since it is being billed with group NPI as supervising provider?
Are there any helpful websites that goes into detail with this issue? The CMS website is not that helpful.

Thanks!
 
Incident to billing is when the MD is listed as rendering instead of the actual rendering NP. Group NPI is used as the pay-to (Box 33A of CMS-1500) regardless if rendering NPI is the MD or the NP. Group NPI should never be used as rendering for professional services. We run into problems all the time where offices think they can use a type 2 NPI as rendering or type 1 NPI as remit when they are with a group whom has an NPI and TIN assigned.
 
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I agree with everything CodingKing said, and want to add that when an NP sees a new patient/problem, this service cannot be considered Incident To, since the MD has not evaluated that particular patient/problem yet.
 
Add-on question

This is helpful. Is it possible for a single facility to have more than one group NPI? I am working with a clinic that has multiple doctor/owners transitioning from outsource billing to in-house billing. While researching previous claims submitted, it seems that each provider has their own group NPI. Is this common?
 
Groups can have multiple NPI's when they are subparts of a parent organization. Some clinics have multiple locations and each location may have their own. Separate hospital campuses may have separate NPI. We have providers that are both early intervention and behavioral health and that causes problems with our claims processing so some of those providers apply for a separate NPI. Some places that do DME and Home Infusion may get a second NPI to separate out the specialties.

Its not very common for each provider in the same group to have different type 2 NPI's, That's usually in the case where each provider has their own distinct corporate entity with their own TIN but just share office space/staff etc.
 
Not subparts

This facility is a single entity, not a subpart. It only has one location. However, each doctor/owner does practice in another hospital location although the hospital(s) in question DO NOT have any affiliation with the clinic I'm working with. My understanding was that each provider uses a rendering NPI but each claim should list the clinic's group NPI as the 'pay to' entity.
 
Gucare said:
This facility is a single entity, not a subpart. It only has one location. However, each doctor/owner does practice in another hospital location although the hospital(s) in question DO NOT have any affiliation with the clinic I'm working with. My understanding was that each provider uses a rendering NPI but each claim should list the clinic's group NPI as the 'pay to' entity.
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Sorry I may have misunderstood your question. They will use their individual rendering NPI in 24J. Clinics Group NPI in 33A. Group TIN in the TIN field (can't remember the field number). It doesn't matter where the service take place. You can see patients in 20 different hospitals all that matters is what entity is being paid for the services. Obviously the TIN reported needs to be the TIN for the group practice.
 
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